Presentation
Right flank neuropatic pain (T10 level).
Patient Data
Note made of transitional anatomy. There are 7 cervical vertebrae, 13 thoracic type vertebrae with 13 pairs of ribs, and 5 lumbar type vertebrae.
At T10/11 there is an ovoid intradural extramedullary mass measuring 10 x 14 x 13 mm which causes leftward displacement and severe compression of the cord, with subtle T2 hyperintensity in the adjacent cord. The mass is vividly T2 hyperintense and T1 hypointense, with vivid enhancement but irregular central region of non-enhancement. There is no extension into the right T10/11 foramen. No dural tail of enhancement.
No further mass or region of pathological enhancement. The remainder of the cord demonstrates normal signal, and there is no thoracic disc herniation.
T2 sagittal screening images through the lumbar spine have been performed, which demonstrate 8 mm L4/5 retrolisthesis of L5/S1 anterolisthesis in the context of bilateral L5 pars defects and bilateral L4/5 facet arthropathy. This does not cause canal stenosis or neural impingement.
Conclusion: Right posterolateral intradural extramedullary mass at T10/11 level causes severe cord compression and edema. Lesion is likely neurogenic tumor; signal characteristics would be very atypical for meningioma.
Case Discussion
This case was pathologically proven to be a spinal neurofibroma.
Spinal neurofibroma are difficult/impossible to categorically distinguish from spinal schwannomas, both usually show a T1 hypointense signal, T2 hyperintense signal and heterogenous enhancement.
Schwannomas are frequently associated with hemorrhage, intrinsic vascular changes (thrombosis, sinusoidal dilatation), cyst formation and fatty degeneration, but these features are not always present.
Portuguese: Este caso corresponde a um neurofibroma intramedular comprovado após ressecção cirúrgica.
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